Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
J Gastrointest Surg. 2019 Dec;23(12):2449-2458. doi: 10.1007/s11605-019-04155-7. Epub 2019 Feb 27.
Distal pancreatectomy (DP) remains associated with significant morbidity, but little data is available about the clinical significance of drain contamination. We explored the incidence, risk factors, and association with surgical outcomes of positive drainage culture (PDC) after DP. In addition, the predictive capacity of early PDC for postoperative pancreatic fistula (POPF) was evaluated.
We retrospectively analyzed our prospectively collected database of patients who underwent DP between January 2005 and December 2015. Surveillance drainage cultures for microorganisms were conducted until drain removal or positive culture. The relationships between clinical variables and PDC were examined.
Of 480 consecutive cases who underwent DP, 176 (36.7%) had PDC. One hundred twelve patients (23.3%) developed POPF according to the 2016 ISGPS definition, with the 90-day mortality rate of 0.2%. Staphylococcus spp. was the most frequent isolate. Thirty-eight (21.6%) patients had PDC within 3 days after surgery, and 129 (73.3%) within the first 7 days of operation. Body mass index (BMI) ≥ 25 kg/m and massive intraoperative blood loss were independent predictors for PDC. PDC had a negative impact on surgical outcomes, including POPF. Early PDC was identified as a newly independent risk factor for POPF. Compared with other microorganisms, those contaminated with Staphylococcus and Klebsiella had higher incidences of POPF.
PDC occurs commonly after DP and plays a critical role in the development of surgical morbidities including POPF. Extreme caution is warranted in patients involving contamination with specific types of microorganisms.
胰体尾切除术（DP）仍然与显著的发病率相关，但关于引流物污染的临床意义的数据很少。我们探讨了 DP 后阳性引流培养（PDC）的发生率、危险因素及其与手术结果的关系。此外，还评估了早期 PDC 对术后胰瘘（POPF）的预测能力。
我们回顾性分析了 2005 年 1 月至 2015 年 12 月期间接受 DP 的患者前瞻性收集的数据库。对微生物进行监测引流培养，直至引流管拔除或培养阳性。检查了临床变量与 PDC 之间的关系。
在 480 例连续接受 DP 的患者中，176 例（36.7%）发生了 PDC。根据 2016 年 ISGPS 定义，有 112 例（23.3%）患者发生 POPF，90 天死亡率为 0.2%。最常见的分离株是葡萄球菌属。38 例（21.6%）患者术后 3 天内发生 PDC，129 例（73.3%）患者在术后 7 天内发生 PDC。BMI≥25kg/m 和术中大量失血是 PDC 的独立预测因素。PDC 对手术结果有负面影响，包括 POPF。早期 PDC 是 POPF 的一个新的独立危险因素。与其他微生物相比，污染有葡萄球菌和克雷伯氏菌的患者 POPF 的发生率更高。
DP 后 PDC 很常见，在包括 POPF 在内的手术并发症的发展中起着关键作用。对于涉及特定类型微生物污染的患者，应格外小心。
